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August 2012

THE DEVELOPMENT OF A GLOBAL HEALTH LEARNING STREAM

In February and March of 2012, I took a 6 week break from my job as a physiotherapist at RSPC to travel down to Nicaragua as part of a group from the University of Saskatchewan.  The group also included Rochelle Yelland, a physiotherapist from Buffalo Narrows and classmate, and Dr. Lori Hanson, a professor of Community Health and Epidemiology at the U of S.  Our goal was to create a program where physiotherapy students and recent graduates would have the opportunity to compare the health problems and challenges faced by residents of the core neighbourhoods in Regina and Saskatoon, residents of northern Saskatchewan, and residents of rural Nicaragua.  Additionally, we wanted to look at how two very different countries were dealing with these problems.

 

I spent time in two cities in Nicaragua; Esteli (located in the highlands of central Nicaragua) and Bluefields (on the Caribbean coast).  Besides the obvious language barrier (most Nicaraguans speak Spanish) I noticed many differences between Canadian and Nicaraguan cultures.  The first was the noise and chaos in the cities.  Horns are always honking, traffic is always wild, music is always playing, and people are always out in the street.  Nicaraguans are also a very socially oriented people; everything stops when there is visiting to be done or conversations to be had.  The famous Latin passion and volatility were much in evidence, and politics was always a hot topic (there have been two civil wars in the last 40 years in Nicaragua, and there had recently been an election when we arrived).  The climate was obviously very different too.  When I left Regina, the temperature was hovering around minus 25, and when I stepped off the plane it was around plus 32, with the temperatures during my stay varying between 27 and 42 degrees depending on where I was.

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I had a chance to speak with many doctors, nurses, and physiotherapists about health and health care while I was in Nicaragua.  Despite the enormous political and economic differences between Nicaragua and Canada, I was surprised at how many health problems were the same.  Diabetes, cardiovascular disease, obesity, and HIV/AIDS are rapidly growing problems in both countries, although Nicaraguans also have to deal with exotic illnesses such as malaria and dengue fever.  It was just as interesting to note the similarities in the strategies being developed to combat these problems.  Much like Saskatchewan, Nicaragua has many geographically isolated indigenous communities with very poor access to health care.  We visited one community that was an hour and a half away from the nearest hospital, and only accessible by panga (a glorified aluminum fishing boat) over open water.  Because of this, efforts are being made both in Saskatchewan and Nicaragua to engage traditional healthcare providers (midwives, traditional healers, herbalists, elders, etc.) and empower those communities to care for their residents as much as possible.  These traditional care providers are also in an excellent position to provide as much health education as possible, as they are generally highly regarded members of their communities. These community oriented, preventative care models have repeatedly been shown to be some of the most effective (and cost effective) delivery methods of healthcare. 

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Getting the chance to meet Nicaraguan physiotherapists was another very interesting experience, as it is always exciting to meet someone in the same profession as you in another country and have the opportunity to share knowledge, compare jobs, and talk about interesting cases.  Walking into the first physiotherapy department was a bit of a surprise; it looked just like any Canadian clinic that I’ve been in.  Somehow I assumed it would have to be different!  However, physiotherapy as a profession is very different in Nicaragua.  There are currently only 1 or 2 universities graduating physiotherapists in the whole country (with a population around 5 million), and there are no private clinics.  This means there are not a lot of physiotherapists to go around; Esteli had 5 in their entire health region, serving a population roughly the same as Regina’s.  We have more than that at RSPC alone!  Physiotherapy is currently a developing profession in Nicaragua; there are no professional or regulatory bodies (for example, we have the Saskatchewan and Canadian Physiotherapy Associations which help to promote the profession, provide post-graduate education, connect physiotherapists with each other, and provide information to the general public) and physiotherapists in Nicaragua remain relatively disconnected with each other and have no post-graduate education opportunities.  They were practically green with envy when we told them about the nearly limitless opportunities we have to become specialized in things like spinal manipulation, acupuncture, or advanced exercise techniques to name a few!  About two weeks after I left though, the very first national meeting of physiotherapists took place, with the objective of working towards developing a Nicaraguan Physiotherapy Association.

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Overall, the project was a success.  I thoroughly enjoyed my visit, met a lot of great people, and learned a lot about a country and culture very different from my own.  With the help of our partners down in Nicaragua, we hope that physiotherapists from the U of S will begin travelling there within the next couple years to repeat and expand on this experience, and bring valuable knowledge home to put into their own practices here in Saskatchewan. - Adam Bue

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